Is it a sign of aging or is it an infection? This confusion often delays diagnosis and treatment, writes Hema Vijay

Restless, confused, flagging appetite or even dullness… all these may not be signs of aging; but might indicate an infectious disease. After the age of 70, infections become very common. In fact, they happen to be one of the most important causes of hospital admission and mortality among senior citizens. “But often, physicians are not able to make an early diagnosis because elderly persons show atypical and confusing symptoms, compared with the symptoms these diseases would produce in the young, and also because many symptoms of infection in the elderly get camouflaged by general age-related symptoms and behaviour,” remarks veteran geriatrician Dr. V. S. Natarajan.

In young persons, the temperature rises following an infection; but, in the elderly, it may not shoot up as much. Again, in the elderly, there may not be much of a cough following a respiratory infection, compared to younger persons. Meanwhile, because lung function is not optimum in the elderly, there is insufficient oxygen supply to the brain, leading to symptoms like restlessness and confusion rather than cough or fever. “Some physicians attribute the patient’s restlessness to ‘elderly behaviour’ and prescribe sedatives rather than drugs to fight infection. This is dangerous and might result in the patient falling into a semiconscious state, coma or even dying,” says Dr. Natarajan. Other atypical symptoms of infection in the elderly are falls, incontinence, loss of appetite and weight, vomiting, dullness and lethargy.

Inconclusive diagnosis

In the young, tuberculosis leads to cough, phlegm, blood in the sputum, fever, chills, and loss of appetite; however, in the elderly, it presents no gross symptom. The individual may feel run down, experience a low-grade fever, dull appetite, cough and loss of weight, and the Mantoux test (for diagnosing TB) might be inconclusive. “White blood cells generally increase following an infection; but in the elderly, this may not happen; hence, the blood count may not be conclusive. An X-ray can reveal a chest infection. Sputum tests might not yield a definite diagnosis, as the elderly person many not be able produce enough saliva; and may pass urine only in dribbles, making it difficult to collect a sample. So, how does one proceed? If the diagnosis is inconclusive, physicians can suspect infection and start treatment; if there is improvement, the treatment can be continued,” suggests Dr. Natarajan.

Immunity compromised

Infection occurs more often in the elderly because their immunity has been compromised, or because they get less-than-adequate nutrition due to loss of appetite. “There may also be comorbid illnesses such as cardiovascular disease or diabetes, which makes them vulnerable to infections,” explains Dr. S. Ramani, general physician.

Prostate enlargement is common in elderly men, which predisposes them to urinary infections. “In elderly women, urinary infection is even more common. Elderly persons who had urinary catheterisation are at increased risk for infections too. They can also develop pneumonia and other respiratory infections,” says Dr. R. Magesh, consultant geriatrician, Apollo Hospitals. In old age, dormant TB can become resurgent. Possible skin infections include cellulitis (with painful legs that feel warm), fungal infections, diabetic boils, painful skin lesions because of resurgent herpes zoster (chicken pox virus) that had been dormant for long. Possible gastro-intestinal infections in the elderly include food poisoning, amoebic infection, typhoid and gall bladder infection, especially following consumption of outdated/hotel food. Heart valve infection is also possible.

A PREVENTIVE MEASURE

Elderly persons can benefit from vaccination, especially those with co-morbid illness. In fact, a section of the medical community recommends a vaccination programme for the elderly, like the one that exists for infants. Influenza vaccine can be taken annually, as new strains emerge every year. Pneumonia vaccine may be taken after age 60, especially by those with asthma, diabetes, kidney disease, history of smoking/alcohol consumption. Pneumonia vaccine gives lifelong immunity. But, if necessary, repeat this vaccination once every 10 years. Tetanus vaccination may be taken once every 10 years (as the elderly are prone to falls and wounds) and following any injury. Oral typhoid vaccine may be taken once in three years.

DOS AND DON’TS

* Wear adequate warm clothing whenever required; avoid chill weather.

* Drink hot water, if possible.

* Avoid cold foods such as ice cream, as bacteria thrive in cold conditions.

* Eat only home-cooked food.

* Eat more citrus fruits, gooseberry, dry fruits and nuts such as almonds and pistachio to improve immunity.

* Maintain personal hygiene, especially of the pelvic region. Keep the area dry.

* Avoid crowded places as infection droplets spread easily in such conditions.

* Exercise regularly to keep fit.